“If we can't keep billing and collections happening during this crisis, then we're not going to have clinicians in the field caring for patients. They're not going to be getting paid and the agency is going to suffer substantially.”
– Melinda Gaboury, COS-C, CEO Healthcare Provider Solutions
To say the national healthcare industry has been rocked by the COVID-19 crisis would be putting it mildly. Swift, efficient and effective patient care is the utmost goal of all healthcare providers, including home health agencies. And we’re here to help.
Our goal, as always, is to arm home health agencies (HHAs) and other providers with the right tools to keep their revenue healthy, so you can focus on the important work of keeping patients healthy.
Melinda Gaboury, COS-C, CEO and founder of Healthcare Provider Solutions, Inc., joined us for an exclusive Q&A session focused not only on the impact of COVID-19, but also how the crisis amplifies other major industry shifts, like the Patient Driven Groupings Model (PDGM).
“We can’t afford – in the days of PDGM implementation, especially – to not be billing as timely as we possibly can,” she says, stressing the importance of keeping revenue cycle management running as smoothly as possible in order to better facilitate the needs of clinicians in the field, serving higher volumes of patients and working with limited resources.
Gaboury, a highly respected expert whose career spans 27 years in home care and 17 years of executive education and speaking experience on home health and hospice revenue cycle management, addresses the most burning questions on the minds of the HHA workforce in this exclusive audio interview.
Home health agencies are having a tough year – implementing PDGM, Review Choice Demonstration in some states, and now, the COVID-19 crisis. What’s the single most important thing agency revenue cycle teams should focus on, right now?
“Revenue cycle teams should focus on getting the claims out the door, not just Medicare claims but all payers that they work with. Without the billing going out, money is not coming in. The number one focus – obviously, other than staying healthy themselves – is to ensure those claims are getting sent, because they are getting processed and paid if they're getting sent.”
What are the early results of the PDGM transition for HHAs, in terms of getting paid accurately?
“If you are getting clean RAPs and clean finals to the MACs, agencies are generally getting paid. It's much better than we anticipated last year when we were educating people on the implementation of PDGM – had that been a failure, had agencies not been getting paid and COVID happened on top of that, it would've been catastrophic to home health agencies.
It is absolutely critical that agencies understand that under PDGM, for 2020 claims, you 100% must use the MBI – the patient’s Medicare Beneficiary Identifier – and you 100% must use that on both the OASIS and the claim.”
How can agencies leverage automation and analytics to avoid negative effects of PDGM and the COVID-19 crisis?
“Electronic signature of orders is imperative. I hope that there is someone within your organization from an operations, analytical and financial standpoint who is still monitoring the situation from the PDGM side of things in addition to what COVID19 is doing to us. Use the reports that are within your systems.
Hang in there as much as you can. Until we get to a point where we can focus more solely on PDGM, but don't give it up at this point, and for anything. Keep billing.”
How are home health revenue cycle teams adjusting to a work-from-home environment, and how can team leaders ensure billing continues to be timely and accurate?
“Home health and hospice agencies have generally had a smooth transition to working from home thanks to having electronic health records and tools like eSolutions that allow home health agency billing teams to work from home.
There needs to be a daily conference call with staff working remotely, concerns and questions that come up need to be addressed, and administrative, operations, supervisory staff need to have access to reports they can print to ensure that the billing and collections are happening as timely as they can and as they were before.
To home health and hospice employees: We appreciate everything that you're doing. We are behind you 100%. We would not be here without you, and we want to try to do everything and anything we can to keep you out there taking care of patients, so that we in turn, can remain healthy as well.”